Health

Trying to navigate America’s complex health care system can be confusing and frustrating. At Impatient, our goal is to empower you. We’ll explain how to get the information you need, and how to overcome bewildering bureaucracies. Impatient is also a place for dialogue and debate about what’s working, what’s not, and how to make health care work for everyone.

Understand your plan

That means knowing what your deductible is, whether there are co-pays, and which doctors and facilities are considered in-network. (Confused by these terms? Check out KPCC’s handy health insurance glossary.)

Freeman recommends calling your insurance company, and asking a customer representative to walk through these details with you.

Santa Monica patient advocate Martine Brousse agrees that people need to ask a lot of questions about their insurance coverage.

She says patients are often hesitant to do this, "and that's usually what leads to a lot of problems."

What sorts of questions does Brousse suggest?

A major one, she says, is this: Is a particular provider or facility considered in-network for my insurance plan?

Get the answers in writing

Let's continue with the question above.

Freeman recommends asking the question in a specific way, to avoid any problems down the line: "Are you participating with my insurance company?"

Brousse is a stickler for proof. So if someone at your doctor's office replies "yes," then get it in writing, she advises.

Brousse continues: If you search on your insurer's website and find that a doctor or facility is in-network, take a screenshot. If you call your insurance company and they provide you with this information over the phone, jot down the employee's name and the time and date of the call.

Yes, these steps require extra effort, Brousse says. But it could save you from being surprised by large bills later on.

Ask your doctor more questions

Now that you've found your preferred doctor, it's time to have that "awkward conversation" about costs that I mentioned last week. Brousse agrees it's a conversation worth having, but she says it shouldn't be an uncomfortable discussion.

"You talk to your doctor about your incontinence and your latest bout of vomiting, so you can talk about money, too," she says.

Doctors shouldn't feel like they're being "put on the spot" with these conversations, Brousse says; "however, providers have a responsibility to explain what they do and why they do it to their patients."

Again, what types of questions are we talking about?

If a doctor says a nurse is going to draw blood, Brousse suggests a patient ask which labs are being ordered to avoid unnecessary duplication.

If a doctor recommends surgery, a patient can ask if there are more conservative alternatives or treatments that could be tried first.

If a doctor recommends a prescription, a consumer can ask if it's a brand-name drug and, if so, if there's an alternative, such as a generic option or a lower dose.

"The doctor is a good first step, especially asking, 'why are we doing this and is it really necessary,'" Brousse says.

But she and Freeman both agree that medical assistants and office managers are the real financial experts. They know how to get financial assistance for pricey drugs and can send blood samples to one lab as opposed to another, based on a patient's request.

Do your homework and then haggle

Let's say your doctor tells you in advance that you'll need a procedure, like knee surgery.

You can ask the doctor's office or hospital what code your procedure would be billed under. Then, patient advocate Lisa Berry Blackstock, of Agoura Hills, recommends visiting a website – like healthcarebluebook.com, fairhealthconsumer.org, or guroo.com – where you can enter a procedure or diagnosis, plus your zip code, and get a ballpark figure for what it should cost.

That way, she says, when people at various healthcare facilities quote you prices, "you've got some negotiating room," she says. With some chagrin, she says, "you need to play places off of each other."

Echoing Brousse, she cautions people to get these quoted prices in writing. Otherwise, she says, "room exists for you to be surprised after the fact, and you never want to be playing catch up if you can help it."

Do you have questions about how to shop for health care? Do you have tips for other consumers on how to successfully shop across providers? Let us know in the comments section below, or e-mail us at Impatient@scpr.org.